Breast cancer in the old medicine

Breast Cancer in History of Medicine : 

Breast Cancer in History of Medicine By Prof. Esam Elkousy Cairo University 2009

the Edwin Smith Papyrus at the Rare Book Room,New York Academy of Medicine : 

the Edwin Smith Papyrus at the Rare Book Room,New York Academy of Medicine

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It describes 8 cases of tumors or ulcers of the breast that were treated by cauterization, with a tool called "the fire drill."

The Edwin Smith Surgical Papyrus : 

The Edwin Smith Surgical Papyrus Case Forty-Five: Instructions concerning bulging tumors on his breast.Examination: If thou examinest a man having tumors on his breast, (and) thou findest that swelling have spread over his breast; if thou puttest thy hand upon his breast upon these tumors, (and) thou findest them very cool, there being no fever at all therein when thy hand touches him; they have no granulation, they form no fluid, they do not generate secretions of fluid, and they are bulging to thy hand.

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Diagnosis: Thou shouldst say concerning him: "One having tumors. An ailment with which I will contend." Treatment: There is no treatment. If thou findest tumors in any member of a man, thou shalt treat him according to these directions. Gloss: "Bulging tumors on his breast." means the existence of swellings on his breast, large, spreading and hard; touching them is like touching a ball of wrappings; the comparison is to a green hemat fruit, which is hard and cool under thy hand, like touching those swellings which are on his breast.

Case Forty-Six : 

Case Forty-Six Instructions concerning an abscess with prominent head in his breast.Examination: If thou examinest a man having an abscess with prominent head in his breast: (and) thou findest a very large swelling protruding on his breast, oily, like fluid under thy hand, while they produce some clamminess of the surface, (and) their faces have no ruddiness. Diagnosis: Thou shouldst say concerning him: "One having an abscess with prominent head in his breast .An ailment which I will treat with cold applications to that abscess which is in his breast."

Hippocrates (460-370 B.C.) : 

Hippocrates (460-370 B.C.)

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The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 B.C.), considered the "Father of Medicine." Hippocrates used the terms carcinos and carcinoma to describe non-ulcer forming and ulcer-forming tumors.

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From the earliest times, physicians have wondered about the cause of cancer. The Egyptians blamed cancers on the Gods.

Humoral theory : 

Humoral theory Hippocrates believed that the body contained 4 humors (body fluids) -- blood, phlegm, yellow bile, and black bile. A balance of these fluids resulted in a state of health. Any excesses or deficiencies caused disease. An excess of black bile collecting in various body sites was thought to cause cancer.

Galen : 

Galen This theory of cancer was passed on by the Romans and was embraced by the influential doctor Galen’s medical teaching, which remained the unchallenged standard through the Middle Ages for over 1300 years. During this period, the study of the body, including autopsies, was prohibited for religious reasons, thus limiting knowledge.

Lymph theory : 

Lymph theory Among theories that replaced the humoral theory of cancer was cancer's formation by another fluid, lymph. Life was believed to consist of continuous and appropriate movement of the fluid parts through solids. Of all the fluids, the most important were blood and lymph.

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Stahl and Hofman theorized that cancer was composed of fermenting and degenerating lymph varying in density, acidity, and alkalinity. The lymph theory gained rapid support. John Hunter (1723-1792) agreed that tumors grow from lymph constantly thrown out by the blood.

Blastema theory : 

Blastema theory In 1838, German pathologist Johannes Muller demonstrated that cancer is made up of cells and not lymph, but he was of the opinion that cancer cells did not arise from normal cells. Muller proposed that cancer cells arose from budding elements (blastema) between normal tissues.

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His student, Rudolph Virchow (1821-1902), the famous German pathologist, determined that all cells, including cancer cells, are derived from other cells.

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Chronic irritation: Virchow proposed that chronic irritation was the cause of cancer, but he falsely believed that cancers "spread like a liquid." A German surgeon, Karl Thiersch, showed that cancers metastasize through the spread of malignant cells and not through some unidentified fluid. Trauma: Despite advances in the understanding of cancer, from the late 1800s until the 1920s, cancer was thought by some to be caused by trauma. This belief was maintained despite the failure to cause cancer in experimental animals by injury.

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Parasite theory: In the 17th and 18th centuries, some believed that cancer was contagious. In fact, the first cancer hospital in France was forced to move from the city in 1779 because of the fear of the spread of cancer throughout the city.

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A Nobel Prize was wrongly awarded in 1926 for scientific research documenting stomach cancer being caused by a certain worm. Scientists were unable to confirm this research, so they lost interest in the parasite theory.

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Bernardino Ramazzini, an Italian doctor, reported in 1713 the virtual absence of cervical cancer and relatively high incidence of breast cancer in nuns and wondered whether this was in some way related to their celibate lifestyle. This observation was an important step toward identifying and understanding the importance of hormonal factors such as pregnancy and infections related to sexual contact in modifying cancer risk.

Renaissance period : 

Renaissance period During the Renaissance, beginning in the 15th century, scientists in Italy developed a greater understanding of the human body. Scientists such as Galileo and Newton began to use the scientific method, which later began to be used to study disease. Autopsies, performed by Harvey (1628), allowed an understanding of the circulation of blood through the heart and body that had remained a mystery.

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In 1761, Giovanni Morgagni of Padua was the first to do something considered routine today. He performed autopsies to relate the patient's illness to the pathologic findings after death. This laid the foundation for scientific oncology, the study of cancer.

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The famous Scottish surgeon John Hunter (1728-1793) suggested that some cancers might be cured by surgery and described how the surgeon might decide which cancers to operate on. If the tumor had not invaded nearby tissue and was "moveable," he said, "There is no impropriety in removing it."

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A century later the development of anesthesia allowed surgery to flourish and the classic cancer operations such as radical mastectomy were developed.

Nineteenth century : 

Nineteenth century The 19th century saw the birth of scientific oncology with the discovery and use of the modern microscope. Rudolf Virchow, often called the founder of cellular pathology, provided the scientific basis for the modern pathologic study of cancer. As Morgagni had correlated the autopsy findings observed with the unaided eye with the clinical course of illness, so Virchow correlated the microscopic pathology.

Management of Breast Cancer : 

Management of Breast Cancer The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization.The writing says about the disease, "There is no treatment." in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit.

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French surgeon Jean Louis Petit (1674–1750) and later the Scottish surgeon Benjamin Bell (1749–1806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882

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Radical mastectomies remained the standard until the 1970s, when a new understanding of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures were developed that proved equally effective.

Halsted : 

Halsted

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1894 Halsted reports on 50 cases of breast cancer treated with Halsted mastectomy Recurrence rate of 6%

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In comparison, European experience with Von Volkman mastectomy Recurrence rates 51 - 82%

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Umberto Veronesi Halsted Mastectomy Modified Radical Mastectomy Quadrentectomy with axillary dissection 1981 NEJM: No survival difference WHO Study

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Sentinel Lymph Node Biopsy Accurate axillary staging without removing all the axillary nodes in early stage breast cancer patients 1990’s: The Next revolution

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1995 Presented use of sentinel lymph node biopsy in breast cancer staging Armando Giuliano

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Thomas Eakins painting of D. Hayes Agnew

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“I do not despair of carcinoma being cured somewhat in the future, but this blessed event will never be wrought by the knife of a surgeon.” Dr. D Hayes Agnew

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1903 Alexander Graham Bell Suggested radium could be placed in a glass tube and inserted into a tumor 1908 George Chicotot Attempted to use radiotherapy for breast cancer Radiotherapy

Cancer treatments: surgery : 

Cancer treatments: surgery Ancient physicians and surgeons knew that cancer would usually come back after it was removed by surgery. The Roman physician Celsus wrote, "After excision, even when a scar has formed, none the less the disease has returned."

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Galen was a 2nd-century Roman doctor whose books were preserved for centuries and who was thought to be the highest medical authority for over a thousand years. Galen viewed cancer much as Hippocrates had, and his views set the pattern for cancer management for centuries. He considered the patient incurable after a diagnosis of cancer had been made.